| NPI | 1013205483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY BRUNER Business Manager 509-262-6406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60211296) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60115733) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2011-07-19 |